Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 48213 | WI |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 48213 | WI |
NPI | 1316928336 |
---|---|
Provider Name | Michael Didinsky |
First Address | Kenosha, WI 53142-7845 |
Second Address | Kenosha, WI 53142-7845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 19/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43521500 | (05) | WI |
H84158 | (02) |